- Medical Misadventure in an Age of Professionalisation by Alannah Tomkins
Victorian Britain, Professionalization, Biography, Masculinity
Alannah Tomkins’s Medical Misadventure in an Age of Professionalisation, 1780-1890, does justice to the richness and complexity of nineteenth-century medical lives and through collective biography effectively resists the temptation to recapitulate the trials and tribulations of medical history’s ‘great men’. It is a crucial contribution to our knowledge of the affairs - quotidian and catastrophic alike - of the ‘regular’ medical practitioner in Victorian Britain, and considers the making and unmaking of professional boundaries in a turbulent era.
The book takes a capacious definition of ‘misadventure’ - incorporating financial, professional, and personal challenges - and acknowledges that “failure and success were never fixed entities” (p.15). Its six chapters each follow a different type of ‘misadventure’ including financial hardship (chapter one), career disappointments (chapter two), negligence and ineptitude (chapter three), murder and abortion (chapter four), insanity (chapter five), and professional stress and suicide (chapter six). Tomkins draws on a close analysis of late eighteenth- and nineteenth-century newspapers, searching for doctors suffering financial failure, allegations of wrongdoing, or suicidality. She is explicit about the debt owed to the recent online publication of digitised newspapers and relied heavily on the British Library Newspapers hosted by Gale. She is reflexive about the limitations of her methodology, but her justification for one exclusion is puzzling, when she notes, “The extant searchable versions of medical journals such as The Lancet and the British Medical Journal merely reveal laudatory histories of practitioners as great, or at least respectable, men” (p. 23). These medical journals were fora for some of the most acidic intra-professional vitriol; indeed, that was almost the raison d’etre of The Lancet in the nineteenth century.
Professionalization is a perennial preoccupation for historians of nineteenth-century medicine but, as Tomkins argues, “a better understanding of the professionalising process in medicine requires attention to halted and truncated careers” (p.2). The book spans the period between the publication of the first medical directory in 1779 to the second Medical Registration Act in 1886. This century witnessed a shift from a “self-defined group loosely or barely represented by London College and Companies,” to a “self-conscious profession” asserted by “specialist publications, collective organisations, regulated training, public service, and the law” (p. 2). This “self-conscious profession” also engaged in a concerted effort to reform their public image and transform lay perceptions of the doctor. They worked hard to shed their avaricious, nepotistic, and ineffectual stereotype and instead adopt an image and identity commensurate with notions of meritocracy, humanitarianism, compassion, and scientificity. As such, medicine became an increasingly aspirational profession with ample economic opportunity. However, this opportunity was “no guarantee of [End Page 228] upward social mobility,” and the crowded markets of England and Wales were often the backdrop to professional and personal failure (p. 2).
The reformation of the medical professional image and identity left practitioners with a paradox. While on the one hand they were supposed to embody and perform disinterested professional judgment, on the other, they needed to maintain a viable income in line with the doctor’s social position. This tension frequently, according to Tomkins, proved problematic. She argues that there was a ‘new urgency’ to intraprofessional rivalries and economic motivations by the 1830s. Unlike historiographical claims to the contrary, Medical Misadventure establishes, “marketplace relations were not wholly superseded by ‘professionalisation’ at any point in the nineteenth century” (p. 7). Indeed, this is key to Tomkins’s claim that failure imposes new ‘occupational norms’ on emergent professions. She suggests that the ideals of the Victorian doctor “developed in such a way as to promote prestige for medical altruism but undermine receipts of hard cash” (p. 7). This book, therefore, challenges assumptions that ‘professionalisation’ applied evenly to nineteenth-century medicine. Tomkins convincingly argues that men might have benefitted from all of the conventional trappings of professional success - GMC recognition, subscription to and publication within medical journals, and an established practice - as well as all of the markers of Victorian middle-class masculinity, and...